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Fluid & Electrolytes

F&E values and critical S/S of imbalances

Hypernatremia cell membrane irritability and severe cellular dehydration results in altered cerebral function, muscle twitching/weakness/contractions (irregular), reduced deep tendon reflexes, decreased contractility
Hypernatremia Causes high aldosterone, corticosteroids, kidney failure, excessive intake (oral or IV), near drowning in saltwater, NPO, increased rate of metabolism, watery diarrhea, fever/infection, excessive diaphoresis, hyperventilation
Hyponatremia reduced excitable membrane depolarization and cellular swelling results in acute or increased confusion (esp. elderly), general muscle weakness, increased G.I. motility (N/D, abd. cramping, hyper sounds), seizures, coma, death; requires K+ monitoring
Hyponatremia Causes low aldosterone, diuretics, wound drainage (esp. G.I.), kidney disease/failure, hyperlipidemia, NPO, low-salt diet, hyperglycemia, heart failure, excessive intake or irrigation with hypotonic fluids (ex: BPH patients), SIADH
Hypokalemia reduced cell excitability & diminished tissue response results in resp. weakness/shallow resp.,dysrhythmias,thready/weak pulse,ECG changes(flat T wave),skeletal muscle weakness, flaccid paralysis,confusion/irritability,lethargy/coma,N/V/C, paralytic ileus
Hypokalemia Causes inappropriate use of diuretics/digitalis/corticosteroids, high aldosterone, NPO, wound drainage (esp. G.I.), vomiting, diarrhea, prolonged NG suction, TPN, kidney disease, alkalosis, water intoxication, hyperinsulinism
Hyperkalemia increased cell excitability (potential spontaneous discharge) & interference w/electrical conduction results in brady, low BP, ECG changes (peaked T, wide QRS), dysrhythmias/heart block/v-fib, muscle twitching, tingling/burning/paresthesias, diarrhea
Hyperkalemia Causes excessive intake of salt substitutes, kidney failure, adrenal insufficiency, uncontrolled DM, acidosis, tissue damage (burns), hyperuricemia, transfusions of whole blood or packed cells, K+ sparing diuretics, ACE inhibitors,
Hypomagnesemia increased membrane excitability(esp.nerve)& Ca++/K+imbalances results in increased nerve impulse transmission(+Chvostek&Trousseaus w/hypocalc.)hyper.deep tendon reflexes,numbness/tingling,painful muscle contractions,tetany, seizures, A/N/C,paralytic ileus
Hypomagnesemia Causes malnutrition, starvation, chronic alcoholism, diarrhea, steatorrhea, Celiac disease, Crohn's disease
Hypermagnesemia S/S after >4mEq/L; reduced membrane excitability results in cardiac arrest risk, brady, low BP, prolonged PR/widened QRS, reduced/absent deep tendon reflexes, weak/absent skeletal muscle contractions, lethargy, coma, resp. insufficiency/failure
Hypermagnesemia Causes decreased kidney excretion (kidney disease) increased intake via antacids, laxatives, IV replacement
Hyperphosphatemia well tolerated by most body systems; problems arise d/t resulting hypocalcemia (increased membrane excitability); treated by managing hypocalcemia
Hyperphosphatemia Causes kidney disease (decreased excretion), hypoparathyroidism, increased intake of phosphorus, tumor lysis syndrome
Hypophosphatemia impact w/chronic low lvls;reduced energy metabolism,raised Ca++ lvls results in weak contractility,decreased SV/CO,reversible cardiac damage,weak sk.muscles->rhabdomyolosis, resp. failure,(decreased bone density)bone fractures,irritability->seizures->coma
Hypophosphatemia Causes malnutrition, starvation, kidney failure, hypercalcemia, malignancy, hyperparathyroidism (excess PTH), hyperglycemia, alcohol abuse, uncontrolled DM, resp. alkalosis, use of aluminum-hydroxide/magnesium-based antacids, hyperalimentation (overfeeding)
Hypercalcemia decreased sensitivity of excitable tissues results in increased HR/BP (severe: decreased HR), dysrhythmias, shortened QT, blood clots, severe muscle weakness, decreased deep tendon reflexes w/o paresthesias, confusion/lethargy, N/V/A/C,abd pain/distention
Hypercalcemia Causes kidney failure, immobility, malignancy, use of thiazide diuretics, excessive oral intake of Ca++/Vit D, hyperthyroidism, hyperparathyroidism, use of glucocorticoids, dehydration
Hypocalcemia increased membrane excitability results in paresthesias in hands/feet,muscle twitching/painful cramps or spasms,tetany, +Trousseaus/Chvostek signs,weak/thready pulse,prolonged ST/QT,increased peristalsis,D,loss of bone density, bone pain, change in height
Hypocalcemia Causes end stage kidney disease, immobility, wound drainage(esp.GI), diarrhea, steatorrhea, lactose intolerance, acute pancreatitis, alkalosis, hyperphosphatemia, hyperproteinemia, removal/destruction of PT glands, excess Ca++ binders,Celiac sprue,Crohns disease
Sodium (Na+) Normal Level 136-145 mEq/L
Potassium (K+) Normal Level 3.5-5.0 mEq/L
Calcium (Ca++) Normal Level 9.0-10.5 mg/dL or mg %
Magnesium (Mg++) Normal Level 1.3-2.1 mEq/L
Phosphorus (P) Normal Level 3.0-4.5 mg/dL
Chloride (Cl-) Normal Level 98-106 mEq/L
Created by: terfling